Healthcare Provider Details

I. General information

NPI: 1073793592
Provider Name (Legal Business Name): KIMBERLY L FARNSWORTH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 N PALMER RD
BETHESDA MD
20889-5851
US

IV. Provider business mailing address

4954 N PALMER RD
BETHESDA MD
20889-5630
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-8554
  • Fax: 301-319-7081
Mailing address:
  • Phone: 301-295-8554
  • Fax: 301-319-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010002666
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110002666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: